Fundamentals of Health Workflow Process Analysis and Redesign

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Fundamentals of Health Workflow Process Analysis
and Redesign

• Unit 10.11
• Maintaining and Enhancing Improvements

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Unit Objectives

• Upon successful completion of this unit, you
  should be able to
• Design control strategies for clinic processes.
• Develop and present a sustainability and
  continuous improvement plan for a healthcare
  setting
• Working with practice staff, develop a set of
  plans to keep the practice running if the EHR
  system fails.
• Working with practice staff, evaluate the new
  processes as implemented, identify problems and
  changes that are needed

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Topics Unit 10.11

• CQI
• Process Control
• Business Continuity Plan
• Natural Disaster
• Pandemic
• Downtime

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Sustainability

• Important
• Realize full potential
• Organizational metrics and methods

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CQI

• The philosophy of continual improvement of the
  processes associated with providing a good or
  service that meets or exceeds customer
  expectations, in this case the service of quality
  health care
• Adds an emphasis on understanding and improving
  the underlying work processes and systems in
  order to add value

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CQI

• To achieve continuous quality improvement it is
  not enough to do your best

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QI sustainability Motivators

• Increase ability to achieve collaborative goals
• more release time (60)
• additional money (39)
• Other important motivators were
• improving the quality of care
• professional development
• personal recognition
• personal satisfaction
• Relatively few respondents were motivated by
• career promotion opportunities (10)
• fear of negative consequences (18)

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QI Sustainability Challenges

• Time burden of collecting data during initial QI
  implementation
• Funding
• Personnel or Staff Turnover (loss of memory of
  changes)
• Decreasing interest and enthusiasm over time

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Tips for promoting a culture of quality
improvement

• Educate staff about QI
• Set a routine schedule for reviewing data.
• Communicate results from improvement projects
• Display data where patients can see them.
• Celebrate successes.
• Articulate the values of QI in meetings.
• Provide opportunities for all staff to
  participate in QI teams.
• Reward staff members in their performance
  evaluations.

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Improvement Worksheet Topics

• Primary goal and completion date
• Secondary goals and completion dates
• Process problem areas to address (n)
• Potential causes
• Most likely causes
• Root cause
• Ways to streamline the process
• Ways you can modify the process

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EHR and Quality Improvement

• Data systems that automatically capture and track
  key clinical information, specifically the
  metrics of improvement and here the meaningful
  use criteria will make the QI process more
  efficient and potentially less costly.
• These systems typically require significant
  initial financial and social investment.

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Quality Council

• Establish core quality standards
• Identify Quality metrics
• Identify and define Quality requirements
• Clarify which performance measures are key to
  gauging actual quality improvement performance
• Collect and analyze data to understand key
  variables and process drivers
• Legitimize value of QI to ensure best use of
  resources and measure improvement associated with
  these activities
• Standardize collection and analysis of quality
  Trends
• Educate organization and train key staff

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Process Control

• Process control is a statistics and engineering
  discipline that deals with architectures,
  mechanisms, and algorithms for controlling the
  output of a specific process.
• Statistical process control (SPC) is the
  application of statistical methods to the
  monitoring and control of a process to ensure
  that it operates at its full potential to produce
  conforming product.

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Challenges to SPC in Healthcare

• SPC is now transferring into Healthcare
• SPC was first used in manufacturing industry
• SPC is not frequently included in books on
  medical statistics.
• SPC is a way of thinking which challenges many of
  our fundamental assumptions about how to deliver
  improvement

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Statistical Process Control

• Key tools in SPC are
• Control charts,
• A focus on continuous improvement and
• Designed experiments
• Examines a process and the sources of variation
  in that process
• Reduces waste
• Reduces the time required to produce the product
  or service from end to end

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Statistical Process Control

• Statistical Process Control Activities
• understanding the process
• understanding the causes of variation and
• elimination of the sources of special cause
  variation.
• Monitored using control charts to identify
  variation due to special causes
• Causes for excessive variation must be determined
• Designed experiments
• Pareto charts

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Features of a Control Chart

• Simplicity
• Retain information in the data by plotting
• ease of communication associated with (good)
  graphs
• incorporating statistical thinking.
• Provide guide for continual actionfor common and
  special cause variation.
• Provide reminder that gains lie in reducing
  common cause variation
• Overcome the fundamental limitations and negative
  consequences of comparison with standards.

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• Examples of
• CONTROL CHARTS

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Control Chart of Surgeon Specific Hazard Ratios
Mohammed M A Qual Saf Health Care 200413243-245
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Control Chart of Surgery to Non-surgery Ratio
Battersby J et al. J Epidemiol Community Health
200458623-625
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Business Continuity Plan
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Business Continuity Planning

• Business Continuity Plan
• BCP Team
• BCP Objectives
• BCP Goals
• Essential Functions
• Critical Processes
• Exercises for Success

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BCP Team

• Assemble Core Team to oversee BCP development
• Identify BCP Points-of-Contact for
  organizational units
• Define the overarching BCP program
• Develop a BCP timeline

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BCP Plan Objectives

• Ensure continuous performance of an
  organizations mission essential functions in an
  emergency
• Ensure safety of employees
• Protect essential equipment, records, and other
  assets
• Reduce disruptions to operations
• Minimize damage and losses
• Achieve an orderly recovery from emergency
  operations
• Identify alternate locations and ensure
  operational and managerial requirements are met
  before an emergency occurs.

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Key BCP Plan Goals

• Essential organizational functions, vital
  systems, data and information identified and
  prioritized
• Critical elements capable of being recovered
  quickly to resume operations
• People know who is in charge
• Back-up personnel are trained
• Alternate work locations are predefined
• Checklists are predefined to guide the
  organization in responding to an emergency

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Essential Functions

• Functions that MUST be performed to achieve the
  organizations mission
• Communications
• Vital Records, Systems and Equipment
• Key Personnel
• Alternate Work Sites
• Testing, Training Exercises

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Critical Processes

• Processes or services that must be recovered
  within 24 hours after a disruption to ensure
  resumption of the essential function.
• Includes all resources necessary to carry out the
  critical process
• Personnel
• Data or vital records and
• Systems and equipment

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Exercise for Success

• Exercises are events that allow participants to
  apply their skills and knowledge to improve
  operational readiness
• Goal of exercises is to prepare for a real
  incident involving BCP activation
• Three types of exercises
• Tabletop
• Functional
• Full-scale

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References

1. Shortell, Stephen M., Bennett, Charles, L. and
   Byck, Gayle, R., Assessing the Impact of
   Continuous Quality Improvement on Clinical
   Practice What It Will Take to Accelerate
   Progress.
2. Chin, Marshall H., et al, Sustaining Quality
   Improvement in Community Health Centers
   Perceptions of Leaders and Staff, J Ambul Care
   Manage. 2008 31(4) 319329
3. Mohammed, M A, Using statistical process control
   to improve the quality of health care, Editorial
   in Statistical process control, Quality and
   Safety in Health Care 200413243-245
4. Battersby, J., Flowers, J., Harvey, I., An
   alternative approach to quantifying and
   addressing inequity in healthcare provision
   access to surgery for lung cancer in the east of
   England Epidemiology and Community Health, Theory
   and methods 200458623-625